Associations between problems with crying, sleeping and/or feeding in infancy and long-term behavioural outcomes in childhood: a meta-analysis
- 1Swiss Etiological Study of Adjustment and Mental Health (sesam), Institute of Psychology, University of Basel, Basel, Switzerland
- 2Department of Psychology and Health Sciences Research Institute, Warwick Medical School, University of Warwick, Warwick, UK
- 3Department of Clinical Child and Adolescent Psychology Institute of Psychology, University of Bochum, Bochum, Germany
- Correspondence to Mirja Helen Hemmi, Swiss Etiological Study of Adjustment and Mental Health (sesam), National Centre of Competence in Research, Institute of Psychology, University of Basel, Birmannsgasse 8, CH-4009 Basel, Switzerland;
- Accepted 16 February 2011
- Published Online First 20 April 2011
Background Excessive crying, sleeping or feeding problems are found in approximately 20% of infants and may predict behavioural problems in childhood.
Methods A quantitative meta-analysis of 22 longitudinal studies from 1987 to 2006 that statistically tested the association between infant regulatory problems and childhood internalising, externalising and attention-deficit/hyperactivity disorder (ADHD) problems was carried out; 1935 children with regulatory problems were tested. Cohen's d was used to express the association between regulatory problems and behavioural problems. Heterogeneity of the effect sizes was assessed using the I2 statistic and meta-analysis of variance and meta-regressions were conducted to assess the influence of moderators. Rosenthal's classic fail-safe N and correlation of sample sizes to effect sizes were used to assess publication bias.
Results The weighted mean effect size for the main regulatory problems–behavioural problems association was 0.41 (95% CI 0.28 to 0.54), indicating that children with previous regulatory problems have more behavioural problems than controls. Externalising and ADHD problems were the strongest outcome of any regulatory problem, indicated by the highest fail-safe N and lowest correlation of sample size to effect size. Meta-analyses of variance revealed no significant moderating influences of regulatory problem comorbidity (I2=44.0, p>0.05), type (I2=41.8, p>0.05) or duration (I2=44.0, p>0.05). However, cumulative problems and clinical referral increased the risk of behavioural problems.
Conclusions The meta-analyses suggest that children with previous regulatory problems have more behavioural problems than controls, particularly in multi-problem families. Further studies are required to assess the behavioural outcomes of previously sleep, feeding or multiply disturbed children.
Funding This work is part of the National Centre of Competence in Research (NCCR) Swiss Etiological Study of Adjustment and Mental Health (sesam). The Swiss National Science Foundation (SNF) (project no. 51A240–104890), the University of Basel, F Hoffmann-La Roche and the Freie Akademische Gesellschaft provided core support for the NCCR sesam.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.